Season 7, Episode 4: An Integrative Approach to Optimizing Bone Health with Dr. Keith McCormick

Evelyne: I am very excited. Today we’re talking about a functional and integrative approach to bone health. And I realized as I was preparing for the show and going through your book, how little I actually understand about bone health, and I feel like we don’t talk about bone health the same way that we do about other body systems, and we’re talking about the skeleton. It’s like our foundation. So I find that very interesting.

And whether you’re treating patients with osteopenia or osteoporosis or looking to expand your protocols and learn more. I hope that you get a ton of clinical pearls from this episode. So before we dive into your story, Keith, what is lighting you up this week?

Dr. Keith McCormick: Well, I want to go back to what you just said about the in the part of the skeleton that’s important. And it isn’t something that we just hang our muscles and tendons on. But it is what I think of is the core of our whole existence. And I love helping people and not only understand that, but ways to improve that foundation and that skeletal health that we all need so much to live our lives and enjoy actions.

I think people don’t realize that the skeleton is a true organ that produces hormones. It interacts with essentially every other organ of our body. It has to do with energy regulation. It has to do with, of course, red blood cell production hormones. It’s just a vital part of our everyday, physiology.

Evelyne: That’s absolutely fascinating. And I feel like by the end of this show, we’ll all have a super appreciation for our skeletal health. So you’ve lived the osteoporosis journey personally and professionally. And so I’m curious if you can share your story and how that experience reshaped your view of bone health.

Dr. Keith McCormick: I’ve been an athlete all my life, and as you said I was on the Olympic team. I’ve then been on lots of world championships teams, so I trained really hard my whole life. And when I was 45, I started having a lot of hip pain. I ended up having micro fractures in my hip, and then I started having lots and lots of fractures. I fractured 12 bones in just a short time of five years. And so, I didn’t know what was going on. And then how I found out I had really severe osteoporosis. I went to five different endocrinologists. I found out how bad it was, and they all just wanted to put me on drugs. And I’m not against medications. I’m an integrative doctor. I really think that medications can help.

But the real foundation for improving our overall health and bone health is nutrition and exercise. And I just didn’t want to take their drugs and leave it at that. So I just totally immersed myself in the study of osteoporosis. At that point, I really didn’t know anything much about it. I’m a chiropractor, so I knew a lot about, you know, musculoskeletal issues. But not the real nitty-gritty physiology of bone health.

So I just really immersed myself. I’ve written two books since then, the Whole Body Approach to Osteoporosis and Great Bones recently, last year. So, yeah, I just totally immersed myself all the way so I could figure this out and not only help myself, but help other people, too.

Evelyne: Yeah. What sport were you in?

Dr. Keith McCormick: I was on the Olympic team for a sport called modern pentathlon. So running, swimming, shooting, fencing and riding horses. And then I switched to triathlons.

Evelyne: Oh, wow!

Dr. Keith McCormick: Lots of triathlons, including Ironman Hawaii and other Ironmans. And, now I’m doing ultra distance running. I’ve been doing a 100-mile race this summer in Leadville, Colorado. It’s 100-mile trail race at 10,000 ft. So I’m still training, still working hard.

Evelyne: Wow. That’s amazing. Good luck with that.

So let’s take you back to basics. What is osteoporosis? And the reason I’m asking is that your definition is a little bit different than maybe like the standard definition of osteoporosis.

Dr. Keith McCormick: I think people get osteoporosis and osteoarthritis mixed up. And sometimes you tell people, oh, I have osteoporosis. And they say, oh yeah, I have back pain also, and osteoarthritis is when you have joints that become arthritic, they become they change, they get spurs on them, they degenerate and stuff. But osteoporosis is when your bones themselves, not the joints, but the bones themselves become not only have less density, but they have poor quality. Their microarchitecture has been compromised and the inside of bone that called the cancellous bone, it’s made up of little struts and bars like the inside of an airplane wing. Well, if those little struts and bars are not connected well, or they’re really thin and spindly, they’re not going to be able to maintain the integrity of that bone very well. And that’s when bones become fragile and they easily break.

I think what people don’t realize is that osteoporosis is a combination. You get your bone strength from a combination of bone density and bone quality and a bone density exam, a DEXA exam is really just looking at density. It’s not looking at the bone quality, but half of your bone strength is from quality.

And that’s one of the problems with bone density. But we have to look at both of those aspects. And we can look at bone quality in other ways. But a bone density machine, a bone density exam is really just looking at the density itself and not the quality.

Evelyne: So with DEXA scans, traditionally they’re recommended, is it over 50? Is that right?

Dr. Keith McCormick: Well, I wish that your comment was true. Unfortunately, a lot of times people the doctors will say, well, to a woman, oh, you just went through menopause 55 or something like that. Now it’s time to get a bone density. Or maybe they might say at 60, get a bone density, or for a male, 65 or 70 for a male.

So I wish everybody would not just get it at age 50, but maybe even at age 40 or so. But, oftentimes it’s menopause. That’s the kind of key to a PCP, primary care physician to say to the patient, okay, to a woman, let’s get at bone density at this time. The problem with that is people are losing bone a year or two years, even three years before they actually go through menopause. And we gain our peak bone mass. It maybe about age 30. And after that we slowly start losing bone. And then women reach menopause and then they can lose it very dramatically. Very a huge amount of bone loss can happen for the next 5 to 7 years after menopause.

For men, it’s a much slower, loss and usually later in life. But women, they go through menopause and there’s a huge loss. So to wait until a person reaches menopause to get a bone density isn’t wise. You should get the bone density earlier so you can identify people who really need to be looked after and try to ward any more loss off. It’s easier to maintain bone density than to try to gain it back.

So the more we can identify people that are in trouble with a minimal loss, we identify them. Then we can do things much, much better for them.

Evelyne: So just to summarize, based on your experience, at what age should a man get his first scan? And for a woman you think it should be prior to perimenopause? Or should it be like age 40, for example?

Dr. Keith McCormick: I would say 45 for women, 50 for men.

Evelyne: Okay, okay. That’s helpful. Thank you. So I want to go back to what you said earlier about like bone density doesn’t equal bone strength. And with a DEXA scan we’re looking at bone density. But we also need to be looking at bone quality that is so important. So how do we assess bone quality?

Dr. Keith McCormick: There’s one really good test called that Trabecular Bone Score. And that is a computer analysis of the DEXA itself, of the bone density results themselves. The problem is most facilities do not have TBS capabilities called trabecular bone score or TBS. And in Massachusetts there’s probably only 10 or 15 places with a TBS capability with their bone density. So it’s not like it’s an easy thing to come by.

But that measures the trabecular connectivity within the inside of the bone that I talked about earlier. When those struts and bars that those trabecular are not connected, that the person has weaker bones and a TBS can tell us what is the percentage essentially of the connectivity of these trabecula. So that’s probably the best way.

Another way is a new technique called REM or, an echo light. Those are done through ultrasounds and they’re not a bone density, but it is a way of assessing bone density and bone quality through ultrasound. And some people like those. I’m not completely sold on their efficacy as far as their benefit for helping me help a person improve their bone health because they often, there’s often a real discrepancy between the DEXA score and the echo score, but a lot of people are using them and I think they have some validity. I’m not sure that it’s completely ready for prime time yet, but hopefully in the future that technology will improve and become helpful.

A third way of looking at quality is to look at lab test, laboratory tests and using bone turnover markers is a good way you can use other labs like homocysteine and C-reactive protein. Those are lab tests that you can tell whether a person has higher inflammation or with a homocysteine, you’re looking at the integrity of the collagen fibers within bone. High homocysteine makes those collagen fibers a little too stiff and can increase a person’s risk for fracture. So that’s a quality aspect that you’re looking at.

The bone turnover markers, the C-filler peptide or CTX and the P1NP, it’s called Pro collagen type I N-terminal propeptide. Those two, the CTX is as your classic activity or the osteoclasts of the cells that breakdown the bone, and the P1NP is a measure of osteoblastic that activity or how well you’re forming bone.

So if you have, if you look at the person’s CTX and P1NP, you can get a good look into how the osteoclasts and the osteoblasts are relating to each other. You can see if a person’s peptide is really, really high and their P1NP is not very high, then the osteoclasts are outpacing the osteoblasts and they’re going to be losing bone.

And that’s typically what we see is a person has too high of osteoclasts activity, too aggressive of osteoclast activity. And that number the CTLA peptide number will be over 400, maybe 500 hundred, 600, 700, a thousand. They’re losing bone rapidly. And any time a person is losing bone rapidly, when you go back to your question of quality, rapid bone loss equals poor quality. So it’s another quality indicator.

Evelyne: Thank you. Thank you for explaining that. And I just want to say to the listener, if you’re like running to take notes. We do provide a full transcript of each show at podcast.designsforhealth.com. And I also want to give a little plug for the webinar that you did with us. It was in May of 2023. You can find that on our website in the education section. If you type in osteoporosis there you actually have slides. And it’s very easy to follow because you talked about so many more markers in there.

So you’re making me think of, talking about the bone quality, when people look, or when doctors traditionally look at maybe improvements in T-score as assessed by a DEXA scan, maybe those are improving, right, because of maybe medications or maybe some of the nutrition that they’re doing, maybe they’re strength training. But is that enough?

Dr. Keith McCormick: And that’s a trick question, Evelyne. And the reason why is because so often bone density reports are wrong, and I constantly get people talking to me and they’re saying, oh, I’m losing bone. Or, oh, you know, I gained a lot of bone density. And I look at the two scores that their bone density from two years ago and their current bone density, and they were done completely differently, or they were, done from different facilities or, at one time they measured the first time they measured L1 through L4 accurately, and the next time they actually measured T12 to L3. Instead of looking at apples and apples, they looked at apples and oranges. So I would say 60% at time, I find bone density reports wrong.

Evelyne: Interesting.

Dr. Keith McCormick: And so I always look at the bone density printout, the actual printout from the bone density machine, and where there’s little thumbnail pictures on the printout. And those thumbnail pictures are vital for really being able to assess and analyze whether the bone density was done properly. There’s many places in the flow of how they get bone densities to where things can go wrong. The technician not only has to align the person properly on the table, but they also have to then outline the same vertebrae. They have to outline the hips in a certain way. They have to then do the actual bone density properly, and then the radiologist actually has to read the printout properly.

So there’s lots of places in this whole process where things can go wrong. And unfortunately they do go wrong. So a lot of times determining whether a person really did gain bone density or lost bone density is not as easy as you would think.

Evelyne: That’s really interesting. It actually makes me think of how we could possibly use AI in this context to kind of maybe like standardize some of it.

Dr. Keith McCormick: Yes. Hey, AI is going to revolutionize things. And even in speaking of which, even right now that’s improving. AI is improving things for identifying fractures. So right now I find fractures in X-rays all the time that were not pointed out by the radiologist. And the reason why is because they most radiologists need to see at least at 25%, 20 to 25% loss of bone height in that vertebra to call it a fracture. AI’s going to change that whole thing, and we’re going to be able to identify why many more people with fractures than we are now. So yes, AI is going to help not only in X-rays but in bone density.

Evelyne: That’s really cool. What made me think of it is, there’s a lab, or a company called Clearly Health, I think it’s come up on the show before, and they’re looking at atherosclerosis, using AI and just being able to be more precise and standardized. So that’s really cool that that’s coming. Of course, it’s already in the works, but that will help all of us.

So I want to talk about nutrients. I also want to talk about medications. Actually let’s talk about medications first. You’re not against using medications to treat osteoporosis. I do have a question. When are you a fan of using it for osteopenia, or do you think it should be used just for osteoporosis? And then talk to me about some of the risks and benefits of these drugs? And I know there are many classes of drugs for these. I know that’s a big question.

Dr. Keith McCormick: You’re always trying to trick me with your questions because I because that’s another very tricky question. The question of do you give it, do you give a medication to osteopenia or just osteoporosis? Looking at that point-blank, I would say I would never do a drug for somebody with osteopenia. But that’s not completely true because so many women and men, as they get older, they have so much degenerative joint disease in their spine, so much arthritis in their spine that their spine looks like it’s osteopenia when, in fact, they’re fracturing. And they have osteoporosis, but it looks like it’s osteopenia on the bone density. Only because they have fractures already and because and or because they have degenerative joint disease osteoarthritis. And that makes the skeleton look more, more dense than it really is.

So in those people, if they’re fracturing, they need to go on a medication even though it’s osteopenia, because it’s not really osteopenia, it’s just osteopenia as far as looking at the DEXA scan, the score of the DEXA.

But if we get rid of osteoarthritis, and we just look at the spine and non-arthritic spine, if a person has osteopenia, I don’t think I would ever put them on a medication.

The thing to do with them is nutrition, exercise, diet. The way we live our life, that’s the most important. And even when people have osteoporosis, lots of times medications are not necessary. We have to look at everything. We look at those bone turnover markers. If we can get their bone turnover markers to be appropriate, in other words, at the CTLA peptide at 350 or 300 so they’re not losing bone, but a very robust P1NP of 40, 50 something like that, which is saying their osteoblasts are doing a really good job and their osteoclasts are not ramped up and they’re not breaking down too much bone. Then we’re going to stabilize that person. And with exercise, we’re going to make their bone quality better.

So no, there’s many times, even with a person who comes to me with osteoporosis, that they don’t have to do medication. But when you start, when a person starts fracturing, then we really have to seriously think about an anabolic drug.

Evelyne: And something that you talk about in your book is that patients are placed on these drugs for, I don’t know if it’s like forever, but, what I got from going through your book is that maybe patients should be on this for like 2 to 3 years and be managed concurrently with diet, exercise, nutritional supplements, perhaps. Can you talk more about that?

Dr. Keith McCormick: The answer to osteoporosis is not medication. The answer to osteoporosis is diet and nutrition and supplements and exercise. That’s the answer. And the short term though, we have to get people out of trouble. We have to get people out of danger of fracturing. And that’s where the medications comes in. It’s like an emergency medicine okay. They’re really, really low in bone density. Their TBS is really low. They’re at high fracture risk or they’ve already fractured. Yes. They need to go on a medication for 2 or 3 years at least, maybe more. But typically not. I would say 98% of my people ifthey’re put on medication, if I suggest the medication, they’re only on it for 2 or 3 years and then they’re not on it again, or if they are very intermittently, but most of the time it’s during that first part where they’re where they’re really in trouble or they’re really at danger of fracturing. That’s when you use the medication to get them out of that danger area.

And all during that time, though, we’re doing other things to improve their whole health, and that is nutrition, exercise, you know, diet and stuff. That’s the that’s the real foundation of improving them.

But that said, many times we have to do all the osteoporosis-specific medications. And there are two kinds of medications. There’s the anti-resorbative medications. That’s the bisphosphonates and Prolia. So there’s essentially five anti-resorbatives. And then there are three anabolics. There’s a few other things in there. But the three anabolics are Forteo, Tymlos, and Evenity. And when a person is fracturing or their bone density is very, very low, then you really should go to an anabolic drug if it’s not so low or they’re not losing bone terribly rapidly or whatever, then an anti resorbative might be the way to go.

Evelyne: Thank you. That’s very helpful. So let’s talk about some of those other factors in the foundational treatment I guess for us to process. So let’s talk about diet first. What are your top recommendations when it comes to like the best diet for bone health?

Dr. Keith McCormick: I always think of protein first because bone is protein. And I know there’s a lot of people out there on the protein wagon right now that are, I think they’re recommending a little too much protein. You know, 110g, 120g, something like that. I think for the average woman of 125 to 135 pounds, maybe 70g or so would be really good. 75 maybe. But I don’t think we have to go up to 100. But the protein is really important.

And it’s hard to even get 70 to 75g of protein. But that’s why it’s great to have whey protein, P protein, hemp protein products, amino acid products, those are really, really helpful. I’d say to me that protein is number one. I know everybody talks about calcium, but I always talk about protein sooner.

But obviously calcium, magnesium, trace minerals are important. I never recommend calcium carbonate. I always recommend like calcium malate chelate, citrate, those are good calciums. Magnesium. You know, 300-400mg magnesium, malate chelate, citrate. A combination of calcium and magnesium is important. I think it’s hard to get enough calcium in our diet. Especially a lot of people don’t eat dairy. And I think it’s really difficult to get that calcium. Of course, vitamin D and I usually suggest 40 to 60ng/mL on the vitamin D, and I don’t think you have to go up to 80, 90, 100. I think that’s overdoing it and can actually be detrimental to your bone health if you go too high in your vitamin D, so just 40 to 60 and then vitamin K. Vitamin K is so important. And I think if people understand the why then they’ll say, okay, yeah, I’m going to take the K because it’s really, really important. So you’re osteoblasts produce this protein called osteocalcin, and osteocalcin, and you need to have osteocalcin to essentially form that bone crystal, but that osteocalcin has to be activated. You have to activate it with vitamin K, and once it’s activated or carboxylated, now we can form bone crystals. So you really need that K there all the time.

So the K, the D, the calcium, magnesium, trace minerals, protein. I’d say those are the most important.

And if you have high C-telopeptide, high bone turnover, those osteoclasts are really, really breaking down a lot of bone, the way to reduce that is antioxidants, because the osteoclasts are kind of a form of a white blood cell. Their activity level is ramped up when we have oxidative stress. One of the products, I’m not sure if I can mention this, but a product that you have at Designs for Health that I really, really like is Resveratrol Synergy and that has resveratrol and quercetin in it. And that’s really good for bringing down that oxidative stress. So I use that all the time.

But antioxidants like alpha-lipoic acid and acetylcycsteine, berberine, resveratrol and quercetin. They all really help calm down those osteoclasts because they’re reducing oxidative stress.

Evelyne: Okay. Yeah. So it’s Resveratrol Supreme. So I asked you about diet and you also went into supplements. But I want to go back to the diet for a little bit. I mean, it seems, I just interviewed Deanna Minich, too, we talked about the rainbow of food and eating that that seems important, obviously, when it comes to antioxidants, with getting magnesium from green leafy vegetables, the protein is important. Any other power foods for bone health? I mean, do you believe that drinking bone broth has benefits for bone health?

Dr. Keith McCormick: I suggest people drink bone broth, but also the collagen. And I think collagen helps, not because of the amino acids, but because of the polypeptide chains within amino acids. And the peptide chains can stimulate directly stimulate those osteoclasts to build up bone. And if you take a person and they have a low P1NP, let’s say a person has a 35 for a P1NP, you give them collagen and bone broth that P1NP will go up five points. And I mean it’s not just a guess. You’ll see it go up. And that’s cool. So, yeah it helps improve those that osteoblastic response to what you’re doing.

Evelyne: That’s great. I’m a big fan of collagen. I want to talk about maybe some other nutrients that we don’t typically think of. I know you’re a fan of delta and gamma tocotrienols. Can you share more about how those can help bone health and maybe some dosing that you use in your patients?

Dr. Keith McCormick: Well, I’m going to get off in a little tangent because that is such an important question. For so many reasons. Well, most people now are starting to become familiar with the endothelial glycocalyx. In the inside part of our blood vessels and if people want to look up one cool thing on the internet, just punch in endothelial glycolcalyx and then, pictures. It’s just beautiful when you can look at that glycolcalyx and see what is inside these bone, these vessels.

And the reason why that’s important is, so the glycocalyx are these little glucose type molecules that stick into the small capillaries of our blood vessels, and they register things like how the blood flow is going through your capillaries and the different chemicals within it. But they’re registering these things and sending signals to the rest of your body to take action to normalize things.

The problem is when people get cardiovascular disease and cardiovascular disease and osteoporosis go hand in hand. And the reason why is because when you have cardiovascular disease, that glycocalyx is typically not working as well. Now we have decreased profusion of blood into our bones. We need blood perfusion into our bones to bring nutrients, but also that glycocalyx is not just in the capillaries of our bones, in the vessels of our body.

So there’s three types of bone cells, osteoblasts that form bone, osteoclasts, tear down bone and osteocytes that are the overall regulators of the osteoblasts, the classic activity in the whole bone remodeling system. But the osteocytes actually have little tubes that connect between them. And similar to capillaries, those little tubes and how osteocytes talk to each other, have a glycocalyx within that little tube.

And when that glycocalyx is not functioning properly, your osteocytes won’t or can’t talk to each other properly. So the whole bone remodeling system gets out of whack. And that’s why when you’re talking about the tocotrienols, why that’s so important. And so a tocotrienol, for people don’t know, for vitamin E you have tocopherols and tocotrienols, and the reason why I use that product is because it helps that annatto-E helps a person lower their LDL, their low density lipoprotein cholesterol.

And I talk about this in my book about PPAR gamma and PPAR gamma is this chemical that your body produces that directly stimulates your osteoclast to break down bone. So when a person has high LDL cholesterol that stimulates their production of PPAR gamma and PPAR gamma stimulates osteoclast activity. So it behooves us to lower our LDLs.

And the tocotrienols help to do that. There’s lots of other things. Red yeast rice helps lower cholesterol, which is really important. There’s different, nitric oxide boosters that are really important to improve that glycocalyx.

We’re getting a little bit on a tangent, but the reason why is because, like I said earlier, cardiovascular disease and osteoporosis go hand in hand. So we want to make sure that person’s blood vessels are functioning well. And if they do, if their blood vessels are functioning well they’re going to get more blood perfusion. They’re going to get better osteoblastic activity and a and a more balanced bone remodeling, more balanced interaction between the osteoclasts and the osteoblasts and the osteocytes.

Evelyne: This is super interesting. I actually had a question for you about the endothelial glycocalyx and the connection to bone health, because you mentioned it in your webinar. And we’ve talked about the endothelial glycocalyx quite a bit on the podcast. We did episodes last year with Dr. Mark Houston and Dr. Christine Burke and Dr. Michael Twyman, but it was really just about cardiovascular health, and I had not been thinking of that connection.

We know that we have certain nutrients that really help to restore the endothelial glycocalyx. So that is super interesting. I’m so glad that you brought that up. I’m just fascinated by that.

Dr. Keith McCormick: So one more thing about vitamin K is that you’re talking about the connection here between osteoporosis and cardiovascular disease. But vitamin K is part of that whole game. There’s this chemical in our body called NF-kappaB.

So anytime you have an inflammatory reaction within a cell, whatever cell that is, we have this stuff called NF-kappaB. And as that rises with oxidative stress we have more NF-kappaB, more inflammation, more production of proinflammatory cytokines. Vitamin K can help reduce that. So anytime you have a reduction in vitamin K, we’re not only going to have less osteocalcin, but also this what’s called a receptor for activator nuclear factor kappaB and then that stimulates the osteoclasts.

But it’s also unhealthy for just as far as bringing up inflammation throughout the whole body. And when we have inflammation, we have more risk for cardiovascular disease and for osteoporosis.

Evelyne: Yeah. It really all boils down to inflammation, right? I have a follow-up question on that. So what about patients who are on blood thinners. What are your thoughts on them with vitamin K? Do you still use it?

Dr. Keith McCormick: I think that’s a really important question. If a person’s on something like Warfarin, then yes, I would have. I would definitely not push high levels of K on that person. But if they’re not on Warfarin, if they’re on another type of blood thinner than they need to be talking to their doctor about the K and, but yes I would, I would not do the K with that.

Evelyne: Okay. So with all of the interventions that you are doing with your patients, how often do you recommend retesting with a DEXA scan? And also how often do you retest some of the other lab markers? It would be confusing, I think on a podcast where you’re listening and you can’t see it, to list all of the labs that you go through in your book or in your webinars, I recommend using those as a reference. But how often are you reassessing those?

Dr. Keith McCormick: For a bone density? That it all depends on what we’re doing. Typically, bone densities are done every two years. That’s what insurance will pay for. But if a person, if we start a person on Evenity or robosozumab, it’s called a sclerosing antibody. It’s one of the anabolic drugs. Then I would do a bone density after only one year. And probably if they did forte or timnose, the other two antibiotics, I would still do it after one year. But typically speaking, I would only do a bone density every two years if a person was put on prednisone, they had some inflammatory disorder and they were put on high doses of prednisone. I would definitely get a bone density more often on that. And we get them every year on that. So there are different reasons why you want to do a bone density sooner than two years. But those are some of the reasons.

As far as the blood tests. And that’s what’s so cool about blood tests, is we can tell when we’re making a major improvement, or whether we’re failing miserably in helping this person by getting bone turnover markers every three or 4 or 5 months. So if we start a person, a person has a C-telopeptide of 600 and we put them on a program, a nutrition diet, exercise supplements, things like that. And we get them down to 400 or so on the C-telopeptide, we know that what we’re doing is working. We don’t have to wait for two years. We know after three or 4 or 5 months, if it stays at 600, we know we’re failing. We need to do something else. So that’s the great thing about getting baseline bone turnover markers, baseline other labs too. And then, I call them therapeutic targets in my book. So we find something that’s wrong. High CTX, low p1NP, high homocysteine, high C-reactive protein. High loss of calcium in the 24 hour urine calcium, any of those things, if we find those things amiss, where we focus on that, we try to improve those indices. And we know right away within a couple months, whether we’re winning the game or not. We don’t wait for two years.

Evelyne: Yeah. That’s great. I think we’d be remiss if we didn’t address the exercise component. So we know that strength training is very important for bone health. Do you also recommend like power type exercises? And then I’m curious, so you as an athlete who did these endurance sports and are still doing endurance sports, do you think that that might perpetuate poorer bone health versus doing more of the strength training?

Dr. Keith McCormick: Definitely. Yes, I think it does. When a person goes crazy and starts doing training for 100 mile races, then I think it is a danger to reduce your bone density. But all during that time you know that I’m training hard. I am really eating well or trying to. I’m getting the protein that I need. I’m also doing weight lifting, like, deadlifts and squats and things like that.

So I’m doing a lot of weight lifting. So exercise is incredibly important and walking doesn’t cut it. If you’re going to spend your time doing certain things, please, please use it. Use a trainer, a physical therapist to help you out because it’s easy to get hurt doing weight lifting. And so you really need to have somebody watching you and making sure you’re doing these exercises with the proper technique.

But yes, that will improve your bone quality. You’re not going to see probably an improvement in bone density, but there will be an improvement in bone quality when you do weight lifting exercises. But it has to be done properly because it’s easy to get hurt.

Evelyne: Yeah. And thankfully we are, as a society, talking more about the importance of weight lifting, especially in women. I see that everywhere right now.

Something else that I wanted to talk about specifically for women. So we know that estrogen is really important. I feel like we haven’t really touched on that enough yet. So with estrogen going down as we go into menopause, we know that it’s recommended now, I believe, to start BHRT, if appropriate for the person under the physician guidance to replace some of that estrogen. But I’m curious, what are your thoughts on that? Is there a way that with taking the BHRT, we really can preserve our bone health so we don’t get osteoporosis? Maybe until we’re like 90 or never?

Dr. Keith McCormick: I’m a very big proponent of BHRT hormone replacement therapy, and I think it has a huge place within bone health. The problem is many people are still stuck in the research from 2001 in the Women’s Health Initiative study, where they used oral estrogen and a large dose of .625. And I think now we’re starting to realize that, it’s safe to use transdermal, whether it’s a gel or cream or patch, I happen to like patches more. I think there’s a lot of differences in women’s skin as far as their ability to absorb estrogen, estradiol. But I think it has a huge place in helping lower C-telopeptide. Estrogen helps other things besides bone, it helps your brain and other organs, too. But as far as I’m concerned, or what I do is, I’m focusing on the skeleton and estrogen estradiol as an immune system modulator to calms down the immune system.

So when you calm your immune system down, you’re going to calm down those osteoclasts because they’re kind of related to the white blood cell. They’re kind of they listen to all the chemicals that are happening in your body. The cytokines that are from the immune system. And when they hear when there’s oxidative stress, when there’s free radicals, when we have interleukin-1, interleukin-6, two necrosis factor, all these cytokines that are causing inflammatory reactions in our body.

They get excited and they do one thing and that’s breakdown bone where estrogen helps rein them back in. And so yes, when a person goes to women, goes through menopause to go on a patch, a low dose like .025 to .375, and some progesterone, I think helps calm down those osteoclasts dramatically and can not only preserve, but I see it improve bone density in some situations.

I think if a woman’s going to approach it through HRT, I don’t think she should think of maybe improving her bone density, but for sure cutting the losses and so forth. And the reason why I say that is because if a person is fracturing and they have a bone density of -4.2, the HRT is not enough, they’re going to still have to do an anabolic drug. They might have to do them at the same time, the anabolic drug and the estrogen at the same time. That’s okay. But you wouldn’t want to just rely on the HRT in that situation. But the HRT is a huge, benefit can be a huge benefit to somebody for stopping that bone loss. And the good thing is, it doesn’t just stop that bone loss. But if a person is now exercising at the same time, wow, they get a lot more benefit. Because remember, if a person takes a bisphosphonate drug, you’re essentially killing off or at least making those osteoclasts sick. And now those osteoclasts can’t signal the osteoblasts to form bone.

So now all bone remodeling goes down. And now exercising doesn’t help as much. But if you on HRT, it calms down their osteoclasts. The osteoblasts can still do their job making bone. And now the exercise in combination can do a way better job.

Evelyne: Super interesting. Thank you for sharing that and sharing those little nuances of this. I have one more question before our wrap up questions, which is around other nutrients that maybe people don’t think about when it comes to bone health. And I know that you use, GT in your practice as well, and it’s a compound that we’ve talked about on the show, geranylgeriniol. Can you talk a little bit about that and its relation to bone health?

Dr. Keith McCormick: Well, it helps improve their ability to produce K2MK4. So the combination of taking the tocotrienols and the GG really helps a lot because we’re not only lowering the LDLs, to some extent, but we’re also now promoting that production, that natural production of our body, the K12Mk4. So, really, it’s a it’s a great combination to kind of do.

Evelyne: Great. Thank you. Okay. I just have three questions that we ask every guest at the end. The first one is just for yourself. What are your three favorite nutrients to take or supplements.

Dr. Keith McCormick: I guess collagen, alpha-lipoic acid. Well, that’s tough. Can I say three things really quick? Calcium, magnesium and N-acetylcysteine. All those would be important.

Evelyne: Sure, sure. Great. And then what are your favorite health practices that keep you resilient and balanced, especially when you’re preparing for a 100 mile race?

Dr. Keith McCormick: I love to be out in the sun. I love to be out in the woods. And I love helping people. I was talking to this woman this morning, and she was unbelievably delightful. She was. I think she was 70 or so. She was from Georgia. I loved her accent. And I’m thinking, God, this is so fun. What I do I’m just talking to her, you feel like you’re in their living room and, and you’re just sitting there on the couch talking. And so I think that’s what keeps me going.

Evelyne: So I love that. That’s amazing. And what is something that you’ve changed your mind about through all of your years in practice?

Dr. Keith McCormick: I wish, and I probably shouldn’t say this, but I wish I could say I’ve changed my mind about doctors and how they treat nutrition. And, they’re coming around to it a little bit, but I wish that the traditional medical doctor would have a little bit more respect for what nutrition can do for us, and it’s changing, but we got a long way to go.

Evelyne: Yeah, well, thankfully the ones who listen to this podcast are very much aware of the power of nutrition. But it’s true, I do see the tide shifting.

Dr. Keith McCormick: The reason why I say that is because I have a very dear friend and he’s a medical doctor. And we went on a bicycle ride, and I kept saying to him how excited I was that I can take nutrition and change people’s C-telopeptide.

And he goes, no, you can’t. And I said, yeah, I do it all the time because no, you can’t. And even though he’s a friend of mine, even though he likes me and respects me, he could not get it in his head that I can change people’s C-telopeptide, bringing the CTX down by nutrition. He wouldn’t accept that.

Evelyne: Well, there is research on that. They always say, show me the research, but you can usually find it if you look for it. Well, Keith, thank you so much. This has been a delightful conversation. That’s actually the word I would use. I’m so grateful to you for sharing your knowledge, not just on this podcast, but in your book, which is very comprehensive. And again, I do recommend checking that out. Great Bones. And also the webinar that we did with you last year, and just thank you so much.

Dr. Keith McCormick: You’re very welcome. Thanks so much for inviting me on Evelyne. Appreciate it. It was fun.

Evelyne: Absolutely. And thank you for tuning in to Conversations for Health Today. Check out the show notes for resources from this episode. Please share it with your colleagues. Follow rate and give us a five-star review or leave a review wherever you listen and thank you for designing a well world with us.

Voiceover: This is Conversations For Health with Evelyne Lambrecht, dedicated to engaging discussions with industry experts, exploring evidence based, cutting edge research and practical tips.